YOUR HEALTH
IS OUR PRIORITY
OUR MISSION
At Horseware Products Limited, we are proud of our accomplishments and especially proud of our people. Your health and the health of your family are important to us. Each year, we hold an open enrollment in July. Elections you make during open enrollment will remain in effect throughout the plan year, from August 1st through July 31st of the following year, with the exception of qualified life status changes. To be eligible, employee's must be full-time and have been with the company at least 30 days. Please find the enclosed benefit offerings and take some time to review.
FLATLANDS JESSUP INSURANCE GROUP
Our benefit offerings are managed by Flatlands Jessup and they are here to serve you throughout the year if you have any questions at all. Please reach out to Kristy Harrell on any of the following. WHEN
TIME TO ENROLL
Health Insurance
BlueCrossBlueShieldofNC
Bi-Weekly Cost
As a full-time employee with Horseware, you are eligible to enroll in one of our group ' s health insurance plans through BCBS of NC.
The GOLD plan's cost and coverage highlights can be found in the below which lists your bi-weekly costs for coverage which represents your portion of the employee premium
Horseware contributes to each employee's premium based on longevity.
Employee + Spouse = $422.24 Employee + Child(ren) = $375 33 Employee + Family = $766 29
Employee Only = $78 19
Employee + Spouse = $390 96
Employee + Child(ren) = $344 05
Employee + Family = $735 01
Employee Only = $46.92
Employee + Spouse = $359.69
Employee + Child(ren) = $312 77
Employee + Family = $703 74
Health Insurance
As a full-time employee with Horseware, you are eligible to enroll in one of our group ' s health insurance plans through BCBS of NC.
Bi-Weekly Cost
The SILVER plan's cost and coverage highlights can be found in the below which lists your bi-weekly costs for coverage which represents your portion of the employee premium
Horseware contributes to each employee's premium based on longevity
Employee Only = $91.86 Employee + Spouse = $354.30 Employee + Child(ren) = $314 94 Employee + Family = $642 99
Employee + Spouse = $328 06
Employee +
= $288 69
Employee + Family = $616 74
Employee Only = $39.37
Employee + Spouse = $301.81
Employee + Child(ren) = $262 45
Employee + Family = $590 50
Health Insurance BlueCrossBlueShieldofNC
Bi-Weekly Cost
BlueConnectNC.com is your go-to source for information about your health plan Look up in-network doctors, get cost estimates, check claims, progress towards deductibles and more.
Preventive Care. This health plan covers a broad range of preventive services at no charge to you when using an in-network provider
Who's In-Network? In-network providers save you money, so be sure to find doctors, specialists, urgent care facilities and hospitals that are in your plan's network. For more info, visit the website: BlueCrossNC.com/SearchDoctors
How Drug Benefits Work. Getting prescription drugs is simple Learn how a standard plan works for pharmacy and prescription drug coverage at: BlueCrossNC com/RxBenefits
Primary Care Provider (PCP). You can visit your PCP for most medical procedures and services and when you do, you could save money. Once your plan is active, log in to BlueConnectNC.com and choose the in-network PCP you prefer, to waive your 1st 3 copays.
Telehealth. Blue Cross and Blue Shield of North Carolina offers telehealth services from Teladoc With telehealth, you can see or speak with a board-certified doctor or behavioral health specialist via phone, computer or the Teladoc app. Teladoc’s doctors can diagnose symptoms, and some can prescribe non-narcotic medication (if needed and based on your state's laws) and send e-prescriptions to your local pharmacy. This is a $10 copay on both plans
BlueCross BlueShield Contact Info:
1 877 258 3334
www BlueCrossNC com or login to BlueConnectNC com PO Box 35, Durham, NC 27702
To find an In-Network provider visit www.BlueCrossNC.com/find-adoctor-or-facility or call 877.258.3334 for a list of participating providers.
Dental Insurance Keepyoursmilesweet
$19 85 Employee + Child(ren) = $34 12
Employee + Family = $55 09
Dentalinsurancehelpspayforall,oraportion,ofthecostsassociatedwithdentalcare,fromroutine cleaningstorootcanals.OurdentalinsuranceisthroughPrincipalandyoumayelecttopurchase coverageifyou'reanactive,full-timeemployee. Employee Only = $2 22
+ Spouse = $6.04
+ Child(ren) = $6.25
+ Family = $12.60
Employee Only = $1.59 Employee + Spouse = $5 40
+ Child(ren) = $5 61
+ Family = $11 97
Plan Highlights:
Every 12 months, one exam is covered in full after a $10 copay.
Prescription glasses: 1 pair of lenses are covered every 12 months with a $10 copay.
Frames: covered up to $150 every 24 months; 20% off amount over the allowance.
Lens enhancements: Standard progressive lenses covered once every 12 months with $65 copay.
Elective contacts: Covered up to $150 every 12 months with a $40 copay for fitting and evaluation.
For additional information and plan details, please refer to the Summary of Benefits.
Rates are based on bi-weekly payroll deductions.
Please visit https://eyedoclocator.eyemedvisioncare.c om/mutual/en to locate an In Network Provider.
As always, you may also consider one of our many in-network online options including Glasses.com, ContactsDirect.com, LensCrafters, RayBan, Target Optical and Oakley.
Life Insurance
Horsewareprovidesa$35,000termlifeinsurancebenefittoallactivefulltimeemployeesat nocosttoyou.Thisofferingprotectswhatmeansthemost,thepeopleyoulove.Ifsomething weretohappentoyou,yourlifeinsuranceproceedswouldgotothepeopleyou'vedesignated asyourbeneficiaries. Thisbenefitis100%EmployerPaid.
HorsewarealsoprovidesadditionalGroupTermLifeInsuranceateachEmployee’scost. Employee’scanpurchaseupto5xtheirAnnualSalarywithamaximumof$100,000 GuaranteedIssueand$250,000withEvidenceofInsurability. NotethatGuaranteedIssueis onlyavailableduringthis2024OpenEnrollmentPeriodorafteraNewHire’sProbationary Periodisexhausted. Afterwards,benefitscanbepurchaseduponapprovedEvidenceof Insurability. Employeescanalsopurchaseupto$15,000GuaranteedIssueonSpousesand $10,000onChildren.
Short-Term Disability
Horsewareprovidesshort-termdisabilityatnocosttotheemployeeandisusedasanincome replacementbenefitthatprovidesapercentageoftheirearningsonaweeklybasiswhenthe employeeisofoutofworkonadisabilityclaim.Onceenrolled,employeesareeligibletoreceive50%of theirweeklywagesuptoamaximumof$500perweek(60%upto$1,200perweekforSupervisors, Managers,andDirectors)iftheybecomesickordisabledandwillstartonthe15thdayandareeligible toreceiveitsbenefitsupto24weeks.
The Best
Long-Term Disability
For Your Family
Horsewareprovideslong-termdisabilityatnocosttotheemployeeandisusedasanincome replacementbenefitthatprovidesapercentageoftheirearningsonaweeklybasiswhenthe employeeisofoutofworkonadisabilityclaim.Onceenrolled,employeesareeligibletoreceive50%of theirweeklywagesuptoamaximumof$3,000permonthiftheybecomesickordisabledandwillstart onthe180thdayandareeligibletoreceiveitsbenefitsupto24months.
GlossaryofHealthCoverageandMedicalTerms
AllowedAmount-Maximumamountonwhichpaymentisbasedforcoveredhealthcareservices.Thismaybecalled“eligible expense, ”paymentallowanceor“negotiatedrate”Ifyourproviderchargesmorethantheallowedamount,youmayhavetopay thedifference (SeeBalanceBilling)
Appeal-Arequestforyourhealthinsurerorplantoreviewadecisionoragrievanceagain
BalanceBilling-Whenaproviderbillsyouforthedifferencebetweentheprovider’schargesandtheallowedamount For example,iftheprovider’schargeis$100andtheallowedamountis$70,theprovidermaybillyoufortheremaining$30.A preferredprovidermaynotbalancebillyouforcoveredservices
Co-insurance-Yourshareofthecostsofacoveredhealthcareservice,calculatedasapercent(forexample,20%)ofthe allowedamountfortheservice Youpayco-insuranceplusanydeductiblesyouowe Forexample,ifthehealthinsuranceor plan’sallowedamountforanofficevisitis$100andyou’vemetyourdeductible,yourco-insurancepaymentof20%wouldbe $20 Thehealthinsuranceorplanplaystherestoftheallowedamount
Co-payment-Afixedamount(forexample,$15)youpayforacoveredhealthcareservice,usuallywhenyoureceivetheservice Theamountcanvarybythetypeofcoveredhealthcareservice
Deductible-Theamountyouoweforhealthcareservicesbeforeyourhealthinsuranceorplanbeginstopay Forexample,if yourdeductibleis$1,000,yourplanwon’tpayanythinguntilyou’vemetyour$1,000deductibleforcoveredhealthcareservices subjecttodeductible Thedeductiblemaynotapplytoallservices
EmergencyMedicalCondition-Anillness,injury,symptomorconditionsoseriousthatareasonablepersonwouldseekcare rightawaytoavoidsevereharm
EmergencyRoomCare-Emergencyservicesyougetinanemergencyroom
HealthInsuranceAcontractthatrequiresyourhealthinsurertopaysomeorallofyourhealthcarecostsinexchangefora premium
Hospitalization-Careinahospitalthatrequiresadmissionasaninpatientandusuallyrequiresanovernightstay.Anovernight stayforobservationcouldbeanoutpatientcare
In-networkCo-insurance-Thepercent(forexample,20%)youpayoftheallowedamountforcoveredhealthcareservicesto providerswhocontractwithyourhealthinsuranceorplan In-networkco-insuranceusuallycostsyoulessthanout-of-network co-insurance
In-networkCo-payment-Afixedamount(forexample,$15)youpayforcoveredhealthcareservicestoproviderswhocontract withyourhealthinsuranceorplan In-networkco-paymentsusuallyarelessthanout-of-networkco-payments
Network-Thefacilities,providersandsuppliersyourhealthinsurerorplanhascontractedwithtoprovidehealthcareservices
Non-PreferredProvider-Aproviderwhodoesn’thaveacontractwithyourhealthinsurerorplantoprovideservicestoyou You’llpaymoretoseeanon-preferredprovider Checkyourpolicytoseeifyoucangotoallproviderswhohavecontractedwith yourhealthinsuranceorplan,ofifyourhealthinsuranceorplanhasa“tiered”networkandyoumustpayextratoseesome providers
Out-of-networkCo-payment-Afixedamount(forexample,$30)youpayforcoveredhealthcareservicesfromproviderswho donotcontractwithyourhealthinsuranceorplan Out-of-networkco-paymentsusuallyaremorethanin-networkco-payments
Out-of-PocketLimit-Themostyoupayduringapolicyperiod(usuallyayear)beforeyourhealthinsuranceorplanbeginsto pay100%oftheallowedamount Thislimitneverincludesyourpremium,balance-billedchargesorhealthcareyourhealth insuranceorplandoesn’tcover Somehealthinsuranceorplansdon’tcountallofyourco-payments,deductibles,co-insurance payments,out-of-networkpaymentsorotherexpensestowardsthislimit.
PhysicianServices-Healthcareservicesalicensedmedicalphysicianprovidesorcoordinates.
Pre-AuthorizationCertainproceduresorhospitalizationsmayrequirethattheproviderreceiveauthorizations Theprovideris typicallytheonetogothroughtheprocesswiththeinsurancecompanyandobtainpre-authorization
Pre-Determination-Ifyouarehavingamajorproceduredone,yourdoctorordentistcansubmitapre-determinationtothe insurancecompanysoyoucanknowinadvanceoftreatmenthowmuchofthebillyouwillberesponsiblefor
